Purpose: Hyperglycemia upon admission is associated with an increased risk for acute kidney injury (AKI) in ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). However, the relation of this association with the presence of diabetes mellitus (DM) is less studied. Our aim was to evaluate the effect acute hyperglycemia levels on the risk of AKI among STEMI patients with and without DM who were all treated with primary PCI.
Methods: We performed a retrospective analysis of 1351 STEMI patients undergoing primary PCI. Patients were stratified according to admission glucose levels into normal (< 140 mg/dl) mild (140-200 mg/dl) and severe (>200 mg/dl) hyperglycemia. Medical records were reviewed for the occurrence of AKI.
Results: Mean age was 61±12 and 1084 (80%) were males. hyperglycemia upon hospital admission was present in 634/1351 patients (47%). As compared to patients with no or mild hyperglycemia, the rate of AKI was significantly higher among non diabetic patients with severe hyperglycemia (7% vs. 8% vs. 20 %, respectively; p=0.001), while no significant difference was detected among patients with known DM (8%.vs. 13% vs.18 %, respectively ;p= 0.144). In multivariate logistic regression severe hyperglycemia demonstrated a strong trend for prediction of AKI for the entire cohort (OR=1.68, 95% CI 0.97-2.91; P=0.063). When stratifying the model according to DM, severe hyperglycemia emerged as an independent predictor for AKI (OR= 2.46; P=0.018) among non-DM patients however not in patients having DM (OR= 1.22; P=0.620.).
Conclusion: while common among STEMI patients undergoing primary PCI, severe hyperglycemia upon admission is an independent predictor of AKI only in patients without DM.
